THE PUDDLE CLIENT QUESTIONNAIRE
Kindly fill out all fields to the best of your knowledge.
Address Line 2
How did you hear about us?
Social media (facebook)
Family or friend
Community pet event
You have already:
Spoken to us about our swim sessions
Scheduled an appointment
Date of Birth
CANINE HEALTH INFORMATION
Veterinarian Clinic Name
Do you regularly vaccinate your dog?
Has your dog recently suffered any injury? If so, what and when?
Has your dog ever undergone surgery? If yes, type of surgery, and when?
Is your dog currently on any medications? If so, what and why?
Does your dog have any medical condition? i.e. Blind, deaf, epilepsy, incontinence, skin disorders.
NUTRITION & EXERCISE
Describe your dog's daily exercise routine. i.e. walks, crated, play time
What do you feed you dog? i.e. brand / daily amount / treats
Your dog's swimming experience: (Check all that apply)
Never been swimming
Will swim out to fetch a toy
Underwater Treadmill (Vet)
Lake or pond (open water)
Used to swim, but it's been awhile
What are your goals for swimming your dog with us?
How does your dog react to being held or touched?
Are there any behavioral issues we need to be aware of in order to ensure proper handling of your dog?
Will you need assistance with getting your dog from the parking lot into our facility?
I warrant that I am the owner or person responsible for the canine(s) brought to The Puddle, LLC for services, and therefore accept full liability and responsibility for damages to property, injury or death to myself, people, other animals or my own canine arising out of use of the facility and my actions, along with the actions of my canine(s), and accordingly agree to indemnify and hold harmless, The Puddle, LLC, its owners and employees for money damages and attorney fees.
I understand that The Puddle, LLC is not a licensed veterinary facility and does not provide medical procedures. I agree that I am ultimately responsible for determining whether the swim services provided by The Puddle, LLC are appropriate for my dog(s).
I understand that if my dog defecates in the pool, the pool may have to be shut down to contain any damage. Depending on the severity of the damage, the pool may be closed for a minimum of 24 hours. For this reason, the swim session is cancelled, and payment is non-refundable. I, the owner, may be assessed an additional fee of $50 to partially cover the cost of cleanup.
I understand and agree that payment is due at the time of services. I understand and agree that a 12-hour prior notice of cancellation is requested in order that my time slot can be utilized by another customer.
Per my electronic signature below, I certify that I have read and understand this Agreement, and that the information set forth is true and correct. I agree to accept all the terms, conditions, and statements of this agreement, and any rules, regulations, policies and procedures of The Puddle, LLC.
Your Full Name
If you haven't already scheduled an appointment, we will be in touch shortly.
Please note, we are closed on Mondays.
We will also fax a short form to your veterinarian to sign, indicating that your dog will be swimming with us.